Role of innate immunity in the pathogenesis of otitis media

• In this review article, we discuss recent advances in understanding the role of innate immunity in otitis media (OM).
• We will also discuss the mechanisms utilized by pathogens to subvert innate immunity and thereby overcoming defensive responses.
• OM is a serious healthcare problem and a leading cause of hearing loss.
• Understanding the role of innate immunity in the pathogenesis of OM will open up new avenues to design effective non-conventional therapies against the disease.

SummaryOtitis media (OM) is a public health problem in both developed and developing countries. It is the leading cause of hearing loss and represents a significant healthcare burden. In some cases, acute OM progresses to chronic suppurative OM (CSOM), characterized by effusion and discharge, despite antimicrobial therapy. The emergence of antibiotic resistance and potential ototoxicity of antibiotics has created an urgent need to design non-conventional therapeutic strategies against OM based on modern insights into its pathophysiology. In this article, we review the role of innate immunity as it pertains to OM and discuss recent advances in understanding the role of innate immune cells in protecting the middle ear. We also discuss the mechanisms utilized by pathogens to subvert innate immunity and thereby overcome defensive responses. A better knowledge about bacterial virulence and host resistance promises to reveal novel targets to design effective treatment strategies against OM. The identification and characterization of small natural compounds that can boost innate immunity may provide new avenues for the treatment of OM. There is also a need to design novel methods for targeted delivery of these compounds into the middle ear, allowing higher therapeutic doses and minimizing systemic side effects.